Kaitlyn Lewis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1169595 Issued in CA

Practice address

2575 Yorba Linda Blvd
Fullerton, CA 92831-1615

Phone

(714) 992-7808

NPI assigned

Oct 10, 2018

Last updated

Jun 9, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: kaitlyn.lewis.p1@direct.sythc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Santa Ynez Band of Mission Indians

  dba Santa Ynez Tribal Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Santa Ynez, CA
  • NPI 1992779417
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1104391713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 E YANONALI ST APT A",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931032746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 YORBA LINDA BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928311615",
            "telephone_number": "714-992-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "KAITLYN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-10",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "1169595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathy Mackie Lewczyk, MFT
• Delaney Susan Lewellyn
• Sharon Lewis-Bultsma, PSY.D.
• Alia Marguerite Lewis
• Jerald Lewis, CADC II
• Marvin Lewis Jr.
• Taylor Lewis
• Brian Edward Ley, D.D.S.
• Debra Lee Leyel
• Itzel Leyva

• Physician Assistant in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.